To submit a change of address:

1. Open the change of address form by clicking here and print it out.
2. Fill out sections 1 through 5.
3. Mail to:
   
   Medico™ Group
   1515 South 75th Street
   Omaha, NE 68124

This form can also be used to change phone numbers.

Enrollment is easy. Simply follow these instructions:

1. Open the authorization form by clicking here and print it out.
2. Fill out sections 1 through 4.
3. Write "VOID" across a blank unsigned check and attach to the form.
4. Mail to:
   
   Medico™ Group
   1515 South 75th Street
   Omaha, NE 68124

The authorization form can also be used to change bank accounts.

To file a claim:

1. Click on the appropriate claim form below and print it out.
2. Fill out the form as instructed.
3. Mail the claim form and any other required forms (such as billing statements, pathology reports, etc.) to:
   
   Medico™ Group
   1515 South 75th Street
   Omaha, NE 68124

Cancer and Disability Claim Form
Use this form if you have a cancer policy or a disability policy with Medico™ Insurance Company or Medico™ Life Insurance Company.

Hospital Confinement Claim Form
Use this form if you have a hospital indemnity plan with Medico™ Insurance Company or Medico™ Life Insurance Company.

Life Claim Form
Use this form if you have a life insurance policy with Medico™ Life Insurance Company.

Long-Term Care Claim Form
Use this form if you have a long-term care insurance policy with Medico™ Insurance Company or Medico™ Life Insurance Company and you are making a nursing facility care, assisted living care, home health care, or alternative care claim.

Caregiver Supplemental Form
Use this supplemental form, in addition to one of the above claim forms, if you are using a family member or private caregiver in a home care setting.

Attending Physician's Statement
This form is used for all long-term care. It is a form that must be filled out by the physician.

Facility Certification of Care
This is a form for those who are moving from one facility to another or who are going into a facility for the first time. Staff from the facility need to fill out this form.

Monthly Verification of Continuing Care
This is a monthly form to be filled out by facility staff and mailed in with billing each month. This form is used if the person has been in care for 30 or more days.

Private Caregiver Log
This form is to be filled out by approved private caregivers. Contact the Claims Department to verify that a private caregiver is a covered benefit under your policy and how to obtain approval for a private caregiver.